IACH 2021 | Recent advances in the management of acute GvHD

Hi. Good morning or afternoon. I am Iskra Pusic, and I work in Washington University in St. Lois, Missouri, United States. And I, my interest is in transplant and then development of post-transplant complications, primarily GvHD.

There has been a remarkable development in the field in terms of novel treatments for managing GvHD really coming from decades of effort in GvHD community. So, what we have now is on one side, more specific criteria for diagnosis and staging and grading of acute GvHD that are enabling us to then run studies to assess novel agents and have just more informative and more interpretable trial results.

Then on the other side, there is this whole new area of biomarker development where now really we can plan our therapies better and have more personalized approach where we can assess the risk of the patient for development of GvHD on one side, and then the risk of relapse on the other side and know better when we need to use more intense and more aggressive regimens to treat GvHD, or should I say, even when is the patient really at risk to develop more morbid forms of GvHD.

So, in a way, these biomarkers can predict development of GvHD before it’s actually happening. But then also it can help us predict the response to therapy. What we have now available is a drug that has been approved for steroid-refractory GvHD, ruxolitinib. So, this I think is really a great advance in this field. But that being said, really when we think about treatment for acute GvHD, and that goes also for chronic, these patients should really be treated on well-designed clinical trials. There are quite a few I will just to mention a couple: there are still trials of ruxolitinib, there are trials using alpha-1 antitrypsin, which is serine protease inhibitor that’s a promising new drug in the field, trials of IL-22 agonist, and then a trial that is soon going to be open on both sides of the Atlantic using T-Guard, which is a toxin conjugated monoclonal antibody targeting CD3 and CD7. What is interesting in this trial is that it will be comparing this drug to ruxolitinib.

But what I would also like to underline is that on one side we have these drugs that are treating already-established GvHD, but I think that it is important to have trials, and there are more such trials also coming, that are concentrating really on prevention of more morbid forms of GvHD. Here it will be, again, important to balance the risk of relapse and then the risk of developing GvHD. I think that biomarkers are going to play a key role in designing and running such trials.